Background: Currently there is an axiom in international psychiatry that
schizophrenia has a better course and outcome in developing countries than
that in developed countries. Is the axiom of the outcome of schizophrenia
reliable? Methods: Previous international outcome studies of schizophrenia
in developing and developed countries were reviewed, and the results of
a series of longitudinal follow-up studies of patients with schizophrenia
in China were analyzed. Results: There were limitations of previous international
collaborative studies (eg, WHO’s studies) in which withdrawals or
attrition due to death and homelessness and outcome of never-treated
patients were not included in follow-up analyses. The results of longitudinal
studies in rural China indicated that compared with patients 14 years ago
(55.2%), more patients’ family economic status (74.6%) was lower than the
mean level. Compared with never-treated patients 14 years ago (51.4%),
there were still 30.7% patients who never received any antipsychotic treatment.
The outcome of these never-treated patients was poor than those
once received medication. Many patients (8.2%) were homeless in the
14-year follow-up. The outcome of these homeless patients was poor
than those with family caregivers. The rates of mortality and suicide in these
patients were 8.3 times and 37.4 times higher respectively than that in general
population. The outcome of patients with schizophrenia was quite similar
in developing countries. Conclusion: The higher rates of mortality,
homelessness and never-treated among people with schizophrenia in developing
countries might challenge presumed axiom about schizophrenia outcome
in these countries. It is time to reexamine presumed wisdom about
schizophrenia prognosis in developing countries. Given the culture is an
important factor affecting the outcome of persons with schizophrenia, further
systematic and comprehensive assessments of the outcome (eg, nevertreated,
mortality, homelessness, etc) should be conducted.

Background: Currently there is an axiom in international psychiatry that
schizophrenia has a better course and outcome in developing countries than
that in developed countries. Is the axiom of the outcome of schizophrenia
reliable? Methods: Previous international outcome studies of schizophrenia
in developing and developed countries were reviewed, and the results of
a series of longitudinal follow-up studies of patients with schizophrenia
in China were analyzed. Results: There were limitations of previous international
collaborative studies (eg, WHO’s studies) in which withdrawals or
attrition due to death and homelessness and outcome of never-treated
patients were not included in follow-up analyses. The results of longitudinal
studies in rural China indicated that compared with patients 14 years ago
(55.2%), more patients’ family economic status (74.6%) was lower than the
mean level. Compared with never-treated patients 14 years ago (51.4%),
there were still 30.7% patients who never received any antipsychotic treatment.
The outcome of these never-treated patients was poor than those
once received medication. Many patients (8.2%) were homeless in the
14-year follow-up. The outcome of these homeless patients was poor
than those with family caregivers. The rates of mortality and suicide in these
patients were 8.3 times and 37.4 times higher respectively than that in general
population. The outcome of patients with schizophrenia was quite similar
in developing countries. Conclusion: The higher rates of mortality,
homelessness and never-treated among people with schizophrenia in developing
countries might challenge presumed axiom about schizophrenia outcome
in these countries. It is time to reexamine presumed wisdom about
schizophrenia prognosis in developing countries. Given the culture is an
important factor affecting the outcome of persons with schizophrenia, further
systematic and comprehensive assessments of the outcome (eg, nevertreated,
mortality, homelessness, etc) should be conducted.

en_US

dc.language

eng

en_US

dc.publisher

Oxford University Press. The Journal's web site is located at http://schizophreniabulletin.oxfordjournals.org/

en_US

dc.relation.ispartof

Schizophrenia Bulletin

en_US

dc.title

Different Outcomes of Persons with Schizophrenia in Developing and Developed Countries